Epidemiology and prognostic factors of hepatosplenic T-cell lymphoma (HSTL): An analysis of NCDB (National Cancer Database).
Authors: Sara Albagoush, Durva Masih, Gregory Cichon, Laura Cogua, Peter T. Silberstein, Daniel Arthur Ermann
Journal: Journal of Clinical Oncology (2023)

e19544 Background: Hepatosplenic T-cell lymphoma (HSTCL) is a rare T-cell malignancy, associated with rapid disease progression and generally poor outcomes. To date, few studies have been performed that examine outcomes expected survival outcomes and clinical features of this disease. We aimed to perform a large retrospective study with a focus on disease characteristics and overall survival outcomes. Methods: Utilizing the National Cancer Database (NCDB), we identified 434 patients with HSTCL 2004-2020. Patients were selected by ICD-0-3 histology code 9716. Kaplan-Meier curves and survival tables were created to calculate 1-, 5-year survival probabilities for variables including ages, race, sex, facility type, age, insurance, primary site, stage, and adjuvant therapy. Log-rank and cox regression analysis was used to compare the groups within each variable. Results: The cohort consisted of 68.9% male patients and 67.4% Caucasian patients with a median age of diagnosis of 50 years old. The most common type of insurance was private insurance 49.5% then Medicare 24%, Medicaid 16.4% and not insured 5.8% with median distance of 16.1 miles from hospital where they received care. Most patients (56.8%) were treated at academic/ research facilities, followed by comprehensive community cancer programs 22.8%. Mostly located in metro areas (85.5%) with median household income &gt; $ 46000 (43.5%). More cases diagnosed since 2013. The most common primary anatomical site was spleen 91.7% followed by lymph nodes. Stage IV was the most common stage 77.2%t. Overall, 1-, 5- year survival probabilities for patients with HSTCL were 47.4% and 25.4% respectively. Median overall survival time is 11.24 months (95% CI 9.592-12.888). Female patients had better survival outcomes than males with median survival 20.6 months and 9.5 months, respectively. Academic/research centers (12.65 months) and Medicaid (14.98 months) followed by private insurance (11.79 months) had better survival outcomes. As stage increased, overall survival probabilities decreased; stage 1 median survival 12.71 months, stage 4 (11.24 months). Spleen (12.35 months) had better survival outcomes compared to lymph nodes. With regards to treatment modalities, patient who underwent bone marrow transplant (81.64 months) followed by surgery of primary site (14.92 months) followed by multiple agent chemotherapy (11.27 months) had better survival rates compared to all other treatment modalities. Conclusions: This is the largest and most comprehensive study to date on the epidemiology and prognostic factors of Hepatosplenic T cell Lymphoma. The result of our analysis brings up several interesting trends including females had significantly longer survival when compared to males with the same disease. Other major factors influencing survival are facility type, age, sex, race, insurance status, stage, adjuvant therapy and primary site.